Taste disorder in facial onset sensory and motor neuronopathy: a case report

Abstract

Background: Taste disorder is a common symptom in the general population. Several studies have shown that patients with neurological disorders, such as amyotrophic lateral sclerosis and Parkinson's disease, develop taste disturbance. Facial onset sensory and motor neuronopathy (FOSMN) is a rare disease characterized by sensory disturbance and weakness spreading from the face to the limbs caudally. We describe a patient with FOSMN who showed taste disorder as the sole initial symptom.

Case presentation: A 49-year-old man who smoked cigarettes developed taste disturbance. Despite using zinc supplements, an herbal medication, and an ointment, his taste disorder worsened. 4 years later, a tingling feeling emerged at the tip of his tongue and gradually spread to his entire lips. At 55 years of age, he showed difficulty in swallowing, followed by facial paresthesia, muscle atrophy, and weakness in the face and upper limbs without apparent upper motor neuron sign. Cessation of smoking did not improve his taste disturbance, and he was unable to discriminate different tastes on the entire tongue. In an electrogustometric study, electrical stimulation did not induce any type of taste sensation. Blink reflex showed delayed or diminished R2 responses. Needle electromyography revealed severe chronic neurogenic changes in the tongue and masseter muscles. Mild chronic neurogenic changes were also observed in the limbs. In the thoracic paraspinal muscles, active neurogenic changes were detected. Findings of hematological and cerebrospinal fluid analyses, and magnetic resonance images of the brain and spinal cord were unremarkable. One cycle of intravenous immunoglobulin therapy did not improve his symptoms. We diagnosed him as having FOSMN with the sole initial symptom of taste disorder. Nine years after the onset of taste disorder, he developed impaired sensation of touch in the right upper limb and required tube feeding and ventilator support.

Conclusion: Taste disorder can be the initial manifestation of FOSMN and might involve the solitary nucleus.

Keywords: Facial onset sensory and motor neuronopathy; Solitary nucleus; Taste disorder.

Fig. 1

Atrophy of the temporal, masseter, and sternocleidomastoid muscles

Fig. 2

Evaluation of the blink reflex. The blink reflex shows impaired brainstem function with delayed or absent R2 responses after ipsilateral and contralateral stimulation. Arrows indicate latency of each response. Normal values (ms): R1 10.5 ± 0.8, ipsilateral R2 (iR2) 30.5 ± 3.4, and contralateral R2 (cR2) 30.5 ± 4.4 [16]